Yellowish discoloration of body mainly sclera of eye is jaundice and generally indicate liver disease. It occur due to accumulation of bilirubin pigment in the body. Bilirubin pigment is formed after destruction of old red blood cells in the body and after that it is secreted through bile in to stool. Hyperbiliruninemia occur either due to excessive production because of excessive hemolysis. It also occur if there is obstruction in the passage of bilirubin pigment through liver in to small intestine
The most common blood investigation done is Liver Function Test. Bilirubin is raised. In case of obstructive jaundice conjugated part of bilirubin is raised while in hemolysis or other medical cause unconjugated bilirubin is raised. If the cause is hepatitis then enzymes SGOT/SGPT are also raised. Serum alkaline phosphate is marker for obstructive jaundice
Uncojugated bilirubin is raised in Hepatitis patients. Most common cause of hepatitis are alcoholic hepatitis, Viral hepatitis and steaohepatitis. Most common viral infections which cause hepatitis are Hepatitis A, E, B and C infection. Blood test for the presence of these infections should be done in case of acute hepatitis
Total Leucocyte counts is raised in patient with cholangitis. Renal function tests should be done as these patients have dehydration and low blood pressure and RFT can be deranged
The most common first investigation done is Ultrasound abdomen. The dilatation of biliary channels on ultrasound suggest biliary tract obstruction. The level of bile duct dilatations indicate the site of obstruction. CBD stones or mass can be visualized on ultrasound as cause of obstruction
MRI/MRCP is more helpful to delineate biliary anatomy before any interventionThere are guidelines which recommend EUS in these patients before ERCP
Obstruction of the bile flow into the duodenum lead to accumultion of bile pigments.As the cause of jaundice is obstruction it is called as obstructive jaundiceand as it require surgical intervention it is called as surgical obstructive jaundice
Clinical Features of Surgical Obstructive Jaundice
The most prominent clinical feature which distinguish medical jaundicefrom surgical jaundice is pale stool in surgical jaundice. Because of obstruction bile pigments does not reach up to intestine and stools become pale. Patient complain of itching due to accumulation of bile salts in the blood
Liver Function Tests in Surgical Obstructive Jaundice
Total bilirubin level is raised. It is conjugated type of bilirubin which is raised in obstructive jaudice. Serum alkaline phosphatase level is raised, it indicates there is obstruction in bile passage
Ultrasound is the first investigation to be done as it is non-invasive, no radiation exposure and readily available. Dilatation of Biliary radicles is indicative of obstructive biliopathy. Level of biliary tract dilatation is suggestive of site of obstruction. The most common cause of surgical obstructive jaundice is Common Bile duct stones. In old age patients malignancy can be the cause of jaundice. Small CBD stones may be missed on Ultrasound. MRI/MRCP to detect small CBD stones missed on ultrasound. Biliary anatomy is more defined on MRI.
Vitamin Kis administered to correct coagulation profile before any intervention. If patient is in cholangitis proper antibiotic and I.V fluids are administered. Specific treatment depends on the cause of CBD obstruction. The first line of treatment for CBD stones is ERCP stone clearance. Surgery is done for malignant cause of jaundice.